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Microsurgery reveals regional capabilities for pattern reestablishment in somatic carrot embryos.

The extent to which regions of a somatic embryo were committed to a particular developmental fate was explored by surgically removing portions of somatic embryos and observing patterns of regeneration. Through a variety of excisions that resulted in tissue slices ranging from less than 10% to nearly 90% of the original embryo mass, we observed only a few cases where such isolates completely abandoned preexisting patterns of organized growth. Instead, most subcultured portions of the embryonic axis restored all, or part of, a missing complement of the organism. At the shoot apex, a single lost cotyledon was replaced by new cotyledonary structures, although these usually occurred as multiple pairs of cotyledons. If both cotyledons were removed, secondary axes, each with its own cotyledons, typically formed at the embryo midlength. When embryos were divided into shoot and root pieces, the shoot pole usually regenerated a new root, while the original root and rapidly elongated and matured days earlier than uncut controls. Surprisingly, cotyledon regeneration from excised root sections occurred at much greater frequency when the root piece comprised only 10-25% of the embryo mass; larger portions of the root pole rarely produced recognizable shoot structures. These studies indicate that several discrete regions of the embryo are committed to specific types of patterned growth, and that continuity between certain of these regions is required for the maintenance of axial polarity.

Cells, Cultured↗

Technique and results of ovarian microsurgery in preparation for in vitro fertilization.

A microsurgical technique was used to free the ovaries in women with severe adnexal adhesions, specifically to facilitate subsequent egg retrieval for in vitro fertilization. The surgical technique is described in detail. Eighteen of these patients had a single attempt at laparoscopic collection of oocytes. From 15 women in whom ovariolysis had been successful, 27 eggs were obtained (mean 1.8 eggs per patient). Three conceptions occurred following embryo transfer and one other patient conceived spontaneously. These results suggest that ovariolysis before extra-corporeal fertilization is worthwhile in selected cases.

Adult↗

Transsphenoidal microsurgery for craniopharyngioma.

We report on our series of 32 craniopharyngiomas operated on by the transsphenoidal route since 1983. In 15 of 19 patients (79%) with primary transsphenoidal surgery and in 8 of 13 patients (62%) with a transsphenoidal approach following previous surgical procedures, the craniopharyngioma was totally removed. Primary transsphenoidal surgery is a safe and successful procedure for intrasellar and suprasellar infradiaphragmatic craniopharyngiomas. In secondary surgery and in the presence of tumor calcifications the indication for this approach must be considered more carefully. Postoperative posterior pituitary deficiency is a frequent occurrence. Anterior pituitary function usually remains unchanged after surgery except for normalization of hyperprolactinemia.

Adolescent↗

The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma.

We report on eight meningiomas that have been operated on via the transsphenoidal route since May 1988. Six patients harbored cavernous sinus meningiomas with intrasellar extension. The intrasellar tumor extension and the parasellar tumor portion medial to the carotid artery were removed. Decompression of the pituitary gland with normalization of prolactin levels was achieved in all patients. It is a well-tolerated approach to confirm the diagnosis and still allows the option of major transcranial surgery in the event of tumor progression. Additionally, we report complete tumor removal in two rare cases with intrasellar and suprasellar merely subdiaphragmatic meningiomas.

Adult↗

Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery.

BACKGROUND: Third ventricular colloid cysts account for 0.5% - 1.5% of all intracranial tumors. A thorough search of the world literature since 1858 revealed 1167 cases, for which a more than one-third (36%) management mortality was estimated. One third of the reported cases had modern diagnostics and surgery with minimal morbidity and nearly no mortality. The primary goal of this study was to assess the incidence and present-day management outcome of these lesions in the strictly defined area of Eastern Finland. METHODS: In a series of 2000 patients with brain tumors from our catchment area (870,000 inhabitants in eastern Finland) during a 14.5-year period (years 1980-1994), 40 patients (mean age, 45 years; range, 19-75 years, with 21 females) had a third ventricular colloid cyst. Thirty-one patients had transcallosal extirpation of their cysts. One additional tumor was extirpated by the infratentorial supracerebellar route to include simultaneous biopsy of a tectal tumor (lipoma). One elderly male with severe cardiac disease received a ventriculoatrial shunt. Five patients, admitted deeply unconscious, died. In two of these five patients, desperate shunting operations were done, but, in the remaining three moribund patients, no treatment was considered to be of any benefit. Two patients with small tumors are being followed up. RESULTS: The far lateral transcallosal transforaminal extirpation of the cyst has served our patients well. There was no surgical mortality. The outcome was excellent in 30 patients and good in 3 patients. Follow-up time ranged from 2 months to 14.5 years (mean, 4.3 years). There were no tumor recurrences. Despite good surgical results, management mortality was as high as 13%, CONCLUSIONS: The incidence of third ventricular colloid cysts is at least 3.2/1 million/1 year. Even nowadays, up to one fifth of these completely benign and treatable tumors are detected too late, with calamitous consequences.

Adult↗

Role of microsurgery in orchiopexy.

Intra-abdominal tests cannot be completely brought down into the scrotum by conventional methods. Four intra-abdominal testes in 3 patients underwent successful orchiopexy by dividing the spermatic artery and vein near their origin and anastomosing these vessels to the inferior epigastric vessels with the use of microsurgical technique.

Child↗

Urologic microsurgery--current perspectives: I. Vasovasostomy.

Microsurgical procedures are receiving increased attention in urology, and claims of improved results of vasovasostomy performed with operating microscope have been made. This review examines the available results, sometimes conflicting, of both macro- and microsurgical methods of vasovasostomy. The weight of the data leads to the conclusion that improved results of vasovasostomy will occur with the use of the operating microscope regardless of the type of anastomosis performed because increased appreciation of the detail of the small vasal lumen is afforded by optical magnification.

Antibodies↗

Urologic microsurgery -- current perspectives: II. Orchiopexy and testicular homotransplantation.

Reports of microsurgical testicular autotransplantation as a method of dealing with the high undescended testis have prompted this review. Results with various methods are compared. The increasing success being reported with division of the internal spermatic vessels (when certain principles as enumerated herein are followed) leads to the conclusion that the more technically complex method of microsurgical testicular autotransplantation will not come into general use. The opportunities for testicular homotransplantation are rare, and no definitive conclusions can be made concerning this rarely reported procedure.

Arteries↗

Vibrating glass stylets: tools for precise microsurgery on cuticular structures.

Precisely localized lesions in cuticular structures of insects can be produced by fine glass rods, vibrating transversally at frequencies above 100 kHz. The oscillating edge of the glass rod scrapes off the chitinous material at minimal elastic deformation during treatment. The achieved roughness height is in the 0.1 micron range. The method is most fruitfully applied to insect sensilla. Studies of central projections of sensory nerves (degeneration; cobalt staining) profit from the new chance of eliminating selected single sensilla in close vicinity to others which are to remain intact. This can barely be achieved with conventional fine scissors.

Animals↗

Preoperative angiography in reconstructive microsurgery of the maxillofacial region.

The value of preoperative angiography of the donor and recipient sites in the reconstruction of the head and neck is reported. After neck-dissection an angiographic study of the carotid artery is routinely carried out as the vascular anatomy of the donor site can be determined only by angiography once surgery has been carried out. Angiography indicates not only the possible location for the planned microsurgical anastomosis, but also the potential difficulties which can arise from kinking and other changes in the vessel wall. The operative time can be reduced also by better preoperative planning of the best anastomotic sites.

Anastomosis, Surgical↗

Micro-stereometry: a frameless computerized navigating system for open microsurgery.

We are introducing a new type of ultrasonic-based three dimensional (3D) ranging system for the localization of small hand-held surgical tools to be used during operation in open and stereotactic brain surgery. The new device has been extensively tested in the laboratory and showed a linear localization accuracy of +/- .4 mm. The calibration of the system is automatically done by an active calibration frame as well as by pointing to fiducial markers. The position of the tool is sent to a visualization unit and overlaid in realtime on preoperatively scanned computed tomography (CT) and magnetic resonance imaging (MRI) pictures. First clinical tests showed the improved accuracy, handling, and versatility of the new stereometric navigation system, which will soon become the backbone of a computer-aided surgery (CAS) system with a variety of locatable tools.

Brain↗

Current trends in pediatric microsurgery.

Free tissue transfer has become a routine method for the reconstruction of a variety of defects and is commonly employed in both the university and community hospital setting. Free tissue transfer has most often been reported in adult patients and is used to reconstruct defects caused by trauma, tumor, or vascular insufficiency. Several series have reported on free tissue transfer specifically in children, addressing both the similarities and differences employed in the special patient population. This article reviews common microsurgical practices used in treating pediatric patients and discusses etiologies, donor site selection issues, technical considerations including recipient site selection, and the potential for growth disturbances at both the recipient and donor sites.

Child↗